The role of antimicrobial treatment during pregnancy on the neonatal gut microbiome and the development of atopy, asthma, allergy and obesity in childhood

ABSTRACT

Introduction: The use of antibiotics prenatally, during pregnancy, or neonatally may have adverse effects on the neonatal gut microbiome, and adversely affect the development of the infant immune system, leading to childhood atopy, asthma, allergy and obesity.

Areas covered: Vaginal eubiosis and dysbiosis from molecular-based, cultivation-independent techniques, and how this affects the neonatal gut microbiome and early development of the immune system, the association between maternal antibiotics and the beneficial role of vitamin D in the development of atopy, asthma, allergy and obesity, efforts to reduce the use of antibiotics in pregnancy and therapeutic interventions such as vaginal ‘seeding’, probiotics, breastfeeding and neonatal dietary supplementation.

Expert opinion: Currently available research gives insufficient attention to confounding variables. There remains uncertainty as to whether it is relevant that the mother suffered from the same condition as the purported infant outcome variable, for which she may have received antibiotics. In most studies, there is a lack of control for the number of antibiotic courses administered, the timing of use, the use of broad spectrum or narrow range antibiotics, the indication for antibiotics, the dose-dependent nature of the effect, the class of antibiotics used, or a varying degree of risk.

KEYWORDS:

• Allergy
• antibacterial
• antibiotic
• antimicrobial
• asthma
• atopy
• childhood
• obesity and pregnancy

Article highlights

• There is increasing evidence to link the use of antibiotics in pregnancy with subsequent childhood obesity, asthma and atopic disease. This may also apply to prenatal antibiotic use.

• Vaginal birth, breastfeeding and vitamin D may have a protective effect.

• Interventions may include breastfeeding, alterations to infant diet and/or use of probiotics.

• More research is needed before ‘seeding’ can be fully supported.

• Future research must be more robust with respect to correcting for confounding variables and should include long-term follow up.

• Greater efforts should be made to reduce the use of antibiotics in pregnancy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Author contributions

RF Lamont accepted the commission, proposed a framework for the manuscript and provided guidance for the search strategy. S Milliken carried out the literature search, extracted the data, synthesised the evidence and provided the first draft of the manuscript. RF Lamont wrote the Expert Opinion Section and all three co-authors contributed to sequential drafts and the final version.

Additional information

Funding

This paper was not funded